Did I do the right thing?

That's because you're not an addict.

That's because you're not an addict.

It IS being forced, and he's NOT a happy camper. Remember...brain chemistry and structure changes. Change your brain chemistry and you change the way you think. You change your emotional response. You change your ability to make rational decisions.

What made me stop? Losing everything that mattered, including almost losing my life. Having people in my life with the guts to step in and tell me THIS ENDS NOW! If you choose to continue, you're going to prison. Having people who stopped bailing me out of the jams I was getting into. And most importantly, having time away from all mood altering substances long enough to allow my brain to begin to heal so I could actually learn about the disease and learn new ways of dealing with temptation, anger, fear, pain, etc.. I learned the things that triggered a desire to use and did my best to avoid them. I had other recovering people I could call when I was tempted, who would drop whatever they were doing to come to my aid. I had people in my life who loved me enough to look beyond the crazy things I did when I was using and my disease was active. People who knew and know that that's not who I am.

Yes, research shows the addict doesn't have to want treatment for it to work. The thing that's more important than desire to get better is the amount of time spent in appropriate, evidence based treatment. The "magic number" seems to be 90 days. Treatment programs less than 90 days have a significantly lower rate of success (defined as continuous sobriety of one year) than those that last 90 days or longer. We're talking residential treatment.

Of course not! But I think most recovering addicts will tell you there is an enormous sense of relief when they finally "get caught". Isn't it interesting that other diseases are diagnosed, while the addict "get's caught"? If you look at the langauage associated with addiction, it's generally negative and associated with stigma. You freely admit you have a tough time accepting this is a disease. Of course you do. Have you ever really learned ANYTHING about the diease of addiction? I'm not talking about the complications associated with addiction (cirrhosis, infections, sudden death, etc.)? Of course not. If you had, you wouldn't be asking all of these excellent questions. Most people think they "know" about addiction. No they don't. And that is the fault of the educational programs around the country. It's one of the major areas of focus for those of us involved in the advocacy movement.

If there is one thing that is seriously lacking in nursing school is the lack of emphasis on science, especially physiology and pharmacology. We care for physiological beings with pharmacological substances, yet we (nurses) have very little understanding of the pathophysiology of the disease process or the pharmacology of the drugs we're administering to treat these diseases. Can you explain how opioids cause analgesia? I mean other than "they bind to receptors in the brain". Which receptors cause which effects? Which receptor causes euphoria. Why doesn't benadryl help the person who has itching associated with opioid administration? Why does administering nalbuphine reverse itching and respiratory depression from opioids but maintain analgesia? It's this elevated level of knowledge that supposedly seperates us from the concerned volunteer. So, the reason you and almost every other nurse struggles with understanding addiction is based in a lack of understanding of physiology and pharmacology. And its not just nurses. Doctors, pharmacists and many, many other health care "professionals" don't understand this stuff either. I have teamed with a nurse attorney to develop a series of workshops regarding addiction and the legal ramifications associated with the disease. We have canceled them. Why? Because no one was signing up to attend. Nurses told us they don't see addicts in their practice so they don't need the class right now (Yeah....right). I'll never become addicted so why waste my time or money? Ummmm...OK. I lready know everything I need to know about addiction. I seriously doubt that.

One of the things that has been a benefit of the research looking into the science of addiction is the overall function of the brain, which areas are responsible for things like judgment, memory, learning, motivation, etc. We like to think that we consciously decide what we're going to learn and what is going to motivate us. In reality, much of what we learn is below our level of consciousness. Many of the "rules" we live our lives by are learned before we even make it to 1st grade.

The brain is wired at it's most basic level to focus on 2 things:

1. Survival of the organism (you)
2. Survival of the species (procreation)

Anything the brain perceives as accomplishing one or both of these "directives" is rewarded with a jolt of dopamine in the most primitive areas of the brain. So, when you have sex...DOPAMINE! When you eat...DOPAMINE! When you do a great job at work...DOPAMINE! When you nurture and care for your children...DOPAMINE!!

Dopamine + context (what's going on at the time of the activity being rewarded) = I'll do that again.It's the brain's way of ensuring survival. Now...when the activity has become ingrained...essentially a reflex...the brain says "OK...dopamine is no longer needed to assure this activity will continue." So, the brain has a self-limiting ability when it comes to the need for dopamine rewards.

In the potential addicts brain...the person with the genetic susceptibility to addiction...this dopamine reward system isn't the same as the person without the genetic possibility of becoming an addict. In other words, when a non-susceptible person takes a mood altering substance, their brain may find the sensation "interesting" or "pleasurable", but not excessively so. What is more likely to happen is their brain will find the sensation less than wonderful, even unpleasant.

In the potential addict, ingesting a mood altering substance causes a significantly increased level of dopamine. Their brain says, "Oooooooooohhhhhhhhhhhhhhhhhhhhhhhh Baby! THIS is EXCELLENT!!!! I have GOT to do THIS again!" And unlike a natural activity which releases a modest amount of dopamine causing pleasure, the addict's brain dumps tons of dopamine every time. It assures the continued use of the substance. After enough exposure to this substance, their gene for addiction is switched on. They have crossed the line from someone who abuses a substance to someone who REQUIRES the substance! This is the difference between the abuser and the addict. Biochemistry!

The abuser may experience many of the negative consequences the addict experiences. The abuser eventually says, "This sucks! I'm getting in trouble. My boss is threatening to fire me. My wife says she's going to leave. The kids hate me. I have got to stop drinking/using before everything is gone or I end up hurting myself or someone else."

The addict? Their brain needs more drug. But I'm losing everything! The brain needs more drug! My wife left me! The brain needs more drug!! I lost my job! The brain needs more drug!!! You almost killed someone in an accident last night!!

THE BRAIN NEEDS MORE DRUG!!!!!!!!!!

Liking chocolate, motorcycles, white water rafting isn't even close to addiction.

While the brain keeps needing more drug, a variety of areas are beginning to deteriorate. The pre-frontal cortex, the area where judgment and impulse control takes place, begins to function less an less. This means I'm becoming less and less capable of making rational decisions about my drug use, and I certainly can't control my impulse to use. If I have the drug available, then I'm going to use it until it's gone. Once it's gone, I'm going to focus on getting more...nothing else really matters.

When I get the drug, I'm going to use it until it's gone. When it's gone...I'm going to get more....and so on, and so on, and so on.

Another dual effect of addiction is even more frightening. The drugs releasing this exagerrated amount of dopamine means the addict is strongly motivated to continue using the drug. Meanwhile, the "natural" motivators...sex, food, caring for children, doing a great job, playing your favorite game or sport LOSE their ability to motivate a person.

So how does an addict stop? Through an intervention.

When someone hears "intervention", most folks think of the room filled with family, friends, or colleagues. That's only one type of intervention. There are numerous others as well.

Getting pulled over for a DUI is an intervention.

Your spouse threatening divorce is an intervention.

Your boss threatening to fire you...or actually firing you is another intervention.

Ending up in the hospital after an accident (auto, falling down the stairs, or an accidental OD etc.), is an intervention.

Getting arrested for domestic violence, assault, robbery....these are all interventions. The problem is, there are too many "enablers" around that soften the blow of these "natural" interventions. People who want to help the addict by protecting them. They call the boss and lie about the addict being ill. They lend them money for the bills. All this does is allow the addict to keep using and the disease to keep progressing.

A well planned intervention covers every excuse and rationalization the addict has for avoiding treatment.

• I have to pay those bills! (We have them covered while you're in treatment.)
• I can't miss that meeting at work! (The meeting has been postponed until you're out of treatment.)
• What about the kids!? (They're staying with Grandma and Grandpa.)
• If I miss work I'll get fired! (Your boss said to go to treatment. Your job is safe UNLESS you refuse to go to treatment.)
• No way! I'm not going to treatment! I'm not an addict! I can quit anytime I want! (No you can't. You keep saying that but you never stop for long. If you don't go to treatment here's what will happen. You can't come home. You can't see the kids. No one in the family will let you stay with them. No one will give you money or food. You will be fired. And if you still refuse, then your license will be revoked and we will prosecute you for diversion. We know you're ill. We know treatment will be difficult. We know it will take some time to get you to the point where you can return to work. We are willing to do whatever it takes to help you get well and learn to stay clean and sober. We will do anything to help you get well. We will not continue to help you die from this disease.)

An abuser can see the bad things going on in their life. They recognize why it's a problem. They can decide to get help or quit on their own. The addict cannot. They need help. They need an intervention.

Some addicts can't stop even after multiple interventions and multiple treatment sessions. Some addicts will die from this disease. Just as some patients with cancer will die no matter how aggressive the treatment.

As I said in a previous post, I wanted to make people understand what I experienced as an addict. The despair that led to an aborted suicide attempt. The continued use after an accidental OD. The relapses. The loss of my career as a nurse anesthetist. The loss of 2 marriages (one because of my disease, the other because of hers and her refusal to seek help). But as most addicts eventually realize, a nonaddict will never understand completely what it's like to do things so destructive to yourself and the people you love. As I told my nephew...the day you understand what an addict goes through is the day you will be sitting in a meeting with me because YOU are an addict. You will never fully understand what happens for the addict. Be thankful for that. Everyone in recovery in this community feels the same way...We NEVER want to see someone go through this garbage! I don't even want people I don't really like to go through this. It's why I do what I do.

Keep asking questions. Keep reading and studying. Keep reaching out to those who suffer with this disease. We CAN change the way this disease is treated, but it's going to be difficult. That's no reason to stop trying.

I know I will never stop trying.

Jack

Yes, we all have a story... and it all boils down to addiction/alcoholism eventually leads to death if not treated. Imagine how close we have gotten to death. I know that i have gotten real close, maybe not as close as Jack, but we will never know now, and I really don't want to know ! Jack will have to answer abou this liscense,, as far as me, I completed TPAPN. People do it everyday. It is a great program and gives nurses who need it the opportunity for a second chance at life and a second chance at thier career.




If he's taking off his clothes and running through the street naked then, umm.. yeah, he's got a problem.

. Every single nurse that enters TPAPN will do this. We all made it. We sacrifice to recover. I would not have recovered if I had a full bank account and was able to spend money on a whim to buy pills and drugs?? I would have KILLED MYSELF, on accident of course. So, being off of work for a month or so serves more than one purpose.
1. It gives time for the nurse to detox.
2. There is no cash flow to go buy the drug of choice/alcohol.
3. For me this period of unemployment opened my eyes and made me really appreciate my license and it showed me how fast and easily it can be taken away.

Had I been able to keep working through this detox period, I would not have detox'd, I would have used my paycheck to keep buying pills.

He can do it, and he will need to realize that he MUST do it. But, you know what, and I'm going to say this, and I want you to read this carefully. You can't MAKE him do anything. Eventually, the alcohol will beat him down and maybe he will realize what he needs to do. There are homeless people on every street corner, and most of them are alcoholics. You see, they still don't have a problem,, right? BUt they don't have a job, they don't have a home, they don't have a family. They gave it all up for this disease. They were never able to be treated for one reason or another. I know you would hate to see this happen to your friend.

It sounds like they've already been informed at TPAPN. I will tell you again.... TPAPN and Texas BON do NOT play around when it comes to this. I know,, I have been there. I don't want to go back, EVER. It is bad,,, and YES, IT SUCKS..... but .. guess what,, he made his bed, now he has to lay in it. IF he doesn't like it, the Texas BON will take his nursing license away and he'll have to find an other way to get his alcohol. I know I sound mean today. BUt this is how you need to tell him. Really. Mom needs to cut the apron strings and get this boy sober. He needs to realize that no one is going to help him unless he stays sober and works the recovery program he has been given the opportunity to volunteer for. This is a VOLUNTEER program,, no one can make him do it. The ball is rolling already,, he can't back down. He has no choice. Do it, or lose his license. There is really no other choice. I will say it again... the board has NO SYMPATHY for addicted nurses.

SO,, here's what you can tell him the next time he tells you it sucks and he wants to quit.... YOu can tell him... okay, go ahead and quit. BUt guess what.. this will follow you to another state. and YES you will get your license revoked. There is NO STATE in the union that will allow a known alcoholic nurse work while drunk. No state in the union. Tpapn will turn him into the board with no guilty concience and his license will be snatched up so fast he'll be dizzy for days...

Well, if I knew that a friend of mine in aa/na was drunk or high,, heck yes I would be trying to find out what happened and doing what I could to help them stay clean and sober. Thats what we're there for,, to give support and to recieve support. It's a 'group' effort.. no pun intended. But it takes more than one person to keep me sober.

No, I will not get my license back. I have no desire to get it back. I'm doing exactly what I'm supposed to be doing...this IS my purpose. I know, for me, handling my drug of choice on a daily basis would be too dangerous for my safety. As the great philosopher Dirt Harry Said..."A man's (or woman) got to know his limitations." Well, I know mine when it comes to this disease.

At 12 Step meetings, the dynamics are as variable as the individuals in attendance. Generally there isn't lot of confrontation. Most times someone will say a person is in denial or full of fecal material. Most meetings aren't confrontational. That's a different story in treatment and at Caduceus meetings (recovering health care professionals). Addicted health care providers have unique challenges during treatment and recovery. We have a tendency to intellectualize everything. We think our knowledge and training provides us with an immunity. We believe we can "think our way out". WRONG! Also, I can't save anyone and I can't make someone "get" recovery. Recovering addicts "share their experience, strength, and hope." We tell others what it was like when we were using and what it's like now that we're in recovery. We share what has worked for us.

The first 90 days are probably the most crucial. This is when the brain makes it's greatest recuperation. This is the time when abstinence is critical.

That's the primary focus of my consulting business. And you'd be surprised at the number of nurses, doctors, politicians, and everyday people who could care less about this disease and the people who have it. They rarely change their minds based on my story or anyone else's. It doesn't matter to them until it directly affects them (family or colleagues). You are a great example of this. You never really thought much about any of this until this friend started going through all of the garbage with the board of nursing and at his job. That's not a criticism, just an observation. Another observation that could be off base...if you're chasing your friend down the street while he's getting naked...he's most likely on something more than just ETOH. That's also pretty common with addiction.

There is too much information to share it all here. If you're really interested to learn more, follow those links in one of my previous posts and read, read, read.

We have a long way to go before there is a significant change in our culture's attitude regarding addiction. If nurses don't "get it", how can we expect the rest of society to get it? I figure this means job security. It also means too many nurses will have their lives ruined, lose their careers, and many will die needlessly. You can help change that by learning as much a possible and speaking out when necessary.

Jack

Alcoholic Nurse

Irritability, mood swings
• Elaborate excuses for behavior; unkempt appearance
•Blackouts (periods of temporary amnesia)
•Impaired motor coordination, slurred speech, flushed face, bloodshot eyes
•Numerous injuries, burns, bruises, etc. with vague explanations
•Smell of alcohol on breath, or excessive use of mouthwash, mints, etc.
•Increased isolation from others

Drug Addicted Nurse

•Rapid mood and/or performance changes
•Frequent absence from unit; frequent use of restroom
•May work a lot of overtime, usually arriving early and staying late
•Increased somatic complaints necessitating more prescriptions of pain
medications
•Consistently signs out more or larger amounts of controlled drugs than
anyone else; excessive drug wasting
•Often medicates others' patients; may wear long sleeves all of the time
•Increased isolation from others
•Patients complain that pain medication is not effective or they deny receiving
medication
•Excessive discrepancies in signing and documentation procedures of
controlled substances

Mentally Ill Nurse

•Depressed, lethargic, unable to focus or concentrate, apathetic
•Makes many mistakes at work
•Erratic behavior or mood swings
•Inappropriate or bizarre behavior or speech
•May also exhibit some of the same or similar characteristics as chemically
dependent nurses

Note: It is MOST IMPORTANT to look for patterns or changes in behavior. Not all characteristics need to be present to indicate that a problem exists.

One thing I want you to understand is, TPAPN is not punitive. It is not punishment, and this is very important for him to understand. The punishment will come if/when he does not follow TPAPN's rules and does not complete TPAPN. The peer assistance programs were formed as a non punitive,, ALTERNATIVE TO PUNISHMENT and a way for nurses to recover and return to work as a nurse.

AMEN Mag...AMEN!

Jack